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<br />City of Zephyrhills =F1.m:) <br />Pennlt Application <br />~~teReceived -~:~~ % I ,- -~~fu,.Penn/t "I 353 IJ/79'bll~sL"'-lgl <br /> <br />=::i~~;~~~J~~;';;~~ n. (gT/ <br /> <br />Fee Simple TItleh0Ider Name _ _ _ l1lIeholder Phone Nwnb./I II _II <br />Fee Simple TItleh0Ider Adc:kua I <br /> <br />I I Lot. -I <br />I <br /> <br />813-780.0020 <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Blo-Hazard Waste Storage - ANNUAL <br />Comm Exhaust KItchen HoodIDuct <br />Controlled Bum <br />Emergency Gener8tDr < 30 kw <br />Emergency Gener8lDr> 30 kw <br />Rre ProhletIon MaIntenance - ANNUAL <br />-Ol!!!l] ~ ~ ~ <br />c c CL-J <br />Occcc::J <br />Occcc::J <br /> <br />~ c c_~c::J <br /> <br />Sprinkler <br /> <br />Fn A1ann <br /> <br />Hood CleanIng <br />Hood Suppl8SSIon <br /> <br />~ <br />= I ,{jL~ I <br />:?1~~1f~4~~~ <br /> <br />Address I <br /> <br />PlUMBER I <br />Signature <br /> <br />Addressl <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br />OTHER I <br />Signatln <br />Addrus I <br />Oirections: <br /> <br />Are A1ann Ins1aIIalIon <br />Fire Pumps <br />Are Worlcs <br />FJammabIe AppIIc:atJon- ANNUAL <br /> <br />Fuel Tanks <br /> <br />__ I'" -. <br /> <br /> <br />Parcel . <br /> <br />i <br />I <br />I <br />.' <br /> <br />I <br />I <br /> <br />~ i <br /> <br />o <br />o <br />o <br />o <br />o <br />o <br />D Rec:ntatIonaI Burn <br />D Sp8rkIers <br />D SprlnIder Sysl8m JnstaIIdons <br />D S1IIndplpes (Sprinkler Sys) <br />0- Torch RoofIngITar KeIIIe <br />o Waste TIre Storage ANNUAL <br /> <br />Fumigation Tent <br />Hazardous Material (TIer II or RQ Facility) ANNUAL <br /> <br />Hood InstaBatlon <br /> <br />LP/NaU'a1 Gas-lnstaIJatIon <br />LPINatLnI Ga~NUAL Sale <br />PIlIces of AssembIy-ANNUAL <br /> <br />I Valuation of Project <br /> <br />=~~~~~~ <br /> <br />___ LIcense' ~9'7.5L?5~//9K'8 <br />~y I <br />RegIstered Y I N I Fee Curntnt l Y I N I <br />I <br /> <br />Y/N I <br />I <br /> <br />license # <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />license # <br /> <br />Company <br />Registered <br />LIcense # <br /> <br />Y/N I FeeCurntnt I Y/N I <br />I <br /> <br />Y/N'I FeeCurntnt i Y/N I <br />- ~ <br /> <br />Company <br />Registered <br />LIcense # <br /> <br />Fill out application completely. <br />Owner & Connctor sign beck of appkatIor.. not8rized (Or. copy of lIIgr:Ied contraet with owner) <br />If over $2500. a Notice of ComrneI arnent Is required (MechanIC:aJ work over $5000) <br />Supply two (2) sets of dnlWlngs with applicable docurTlelltdol. ' <br />Allow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax NotIce (http://appralser.pascogov.com) <br />